Buprenorphine initiation plateaued before pandemic despite clinical, policy efforts

Key takeaways:

• Buprenorphine initiation increased from January 2016 to September 2018, then plateaued.
• Median monthly buprenorphine retention rates were about 20%.
• This suggests policy and clinical efforts have been lacking.

From 2016 to 2022, initiation of buprenorphine for opioid use disorder increased, then plateaued prior to the COVID-19 pandemic, with a median monthly retention rate of about 20%, according to a research letter published in JAMA.

Kao-Ping Chua, MD, PhD, an assistant professor of health management and policy at the University of Michigan School of Public Health in Ann Arbor, and colleagues identified buprenorphine prescriptions in the United States reported in the IQVIA Longitudinal Prescription Database from January 2016 to October 2022. They calculated the monthly initiation and retention rates, with retention defined as 180 days or more of continuous buprenorphine treatment following initiation.

Among 93,713,163 prescriptions, 3,006,629 patients initiated buprenorphine.

From January 2016 to September 2018, the monthly initiation rate increased from 12.5 to 15.9 per 100,000 people. Beginning in October 2018, there were no significant differences in the initiation rate on a monthly basis.

Overall, the median monthly retention rate was 22.2% with small but significant increases (monthly percent change, 0.08%; 95% CI, 0.005%-0.15%).

“These findings suggest that recent clinical and policy efforts to increase buprenorphine use have been insufficient to meet the need for this medication,” Chua and colleagues wrote. “A comprehensive approach is needed to eliminate barriers to buprenorphine initiation and retention, such as stigma and uneven access to prescribers.”